When is right to disclose secrets, since that defeats the purpose of even maintaining secrecy? This is of particular concern in healthcare, where the focus is directly life-and-death situations.

Edward Snowden has become the
latest, most famous face of whistleblowing. Exposing the incredibly deep, vast
and ubiquitous monitoring of United States’ citizens, Snowden has had to seek
asylum in various countries, like Russia. Many question his “loyalty”.

But
another question concerns the ethics of whistleblowing: When is right to
disclose secrets, since that defeats the purpose of even maintaining secrecy?
This is of particular concern in healthcare, where the focus is directly
life-and-death situations.

The South African Medical
Association (SAMA) reaffirmed its stance in regard to medical practitioners for
blowing the whistle. Primarily, the concern for practitioners is current health
standards, as it is within their working conditions. And, of course, a doctor’s
working conditions are hospitals.

A poorly-run, unhygienic, etc.,
hospital is detrimental to a patient’s health. Sanitation, water, etc. indeed,
are known as the “forgotten foundations of health”. For example, studies in the Public
Library of Science Medicine remind us that

Of course, it’s not merely
diarrhoea that is combatted effectively with effective sanitation. “Lack of
sanitation contributes to about 10% of the global disease burden,” say the authors.

Doctors themselves can only have
so much impact: primarily, health rests with everyone as an individual, in most
cases. Yet we, too, are limited: how do we procure clean water, sanitation,
etc., if we can’t afford it like the 2.6 billion people who do not have access
to a basic toilet or the 884 million people who don’t have access to safe
drinking water. This requires a greater force than we as either professional
medical practitioners or as patients can muster.

Shedding light on the problem is
the first way to dispel the darkness it causes.

As the definition proposed by
Princeton University says, a whistle-blower is “an informant who
exposes wrongdoing within an organization in the hope of stopping it”.
Wrongdoing need not be deliberately or intentionally wrong to be
a wrongdoing. Inadequate sanitation, for example, is a wrong, though it’s
doubtful any one (or several) individual villainously plotted to make it so.

But whatever the reasons,
doctors are in the best position to report wrongdoing or mismanagement.

First, they know how hospitals
should be. Their job’s efficiency – and fellow staff – depends on elements that
should be in place: enough resources, like beds, etc. A deficiency of these
will be apparent and impact the doctor’s ability to do her job. Second, they
are not in a mental, emotional or pain-state like patients are. They can more
reasonably assess the situation given their position and knowledge. Third, they
are on site everyday, able to judge the decline, rise and maintenance of
resources.

Of course, whistle-blowing is
not the only method to solve mismanagement, but it is one method. Independent
accreditation organisations, such as the only one in South Africa, COHSASA, and America’s Joint Commission, are also essential [PDF]. In order to meet accreditation
requirements, criteria are managed to prevent misuse, mistakes and danger before
it happens preventing the need for whistle-blowing in the first place.
Nonetheless, whistleblowing might still be needed, in addition.

SAMA, as we’ve noted, supports
whistle-blowing. This has numerous benefits: anonymity is maintained, attention
is drawn to the right area and the information can be given to the right
authorities. Press coverage can rightfully focus on those in leadership
positions not taking actions (or have been seen doing little to prevent such
states arising).

In the end, the point is that
whistle-blowing should aid in making hospitals better, which therefore aids
doctors – which in turn saves lives. Whistle-blowing then is a part ofmedicine and healthcare and should be considered as such.

- Tauriq Moosa

Tauriq Moosa is a tutor in ethics, bioethics and critical thinking at the University of Cape Town, South Africa. He is currently pursuing a Masters degree at the Centre for Applied Ethics, Stellenbosch University. Read more of his work on his Big Think blog, Against the New Taboo.

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